I'm here totally confused about the the CD4 and VL i.e. CD4 and VL numbers! Just got my last lab results which were taken in October, CD4 464, VL 167. Since I started treatment, almost 2 years ago I have reached the undetectable level once, that was way back to December 2011.

Since then both the CD4 and VL numbers kept fluctuating. I'm not concerned about my CD4 since it never went down the 300's but on the other hand I am worried that my viral load keeps increasing. Tests were taken in a 3 months period, last test being done after 2 months and my VL results were as follows:

April 2012: 83
August 2012: 123
October 2012: 167

First and second tests were discussed with my ID doctor and he mentioned blips which I knew it could happen but 3 blips in a year, I find that very strange and not very convincing.

Also, my last lab results indicated that my CD4 increased to 464 as opposed to 310 in August. Although this is good, it is still confusing since usually as the CD4 increases the viral load decreases.

Such numbers are freaking me out!

Any words of advice would be much appreciated, please.

Thanks!

Response from Dr. McGowan

HI,

Looking at CD and Viral load numbers can often be confusing because there are so many factors that can effect the results.

Some of the issues are:

1) These are dynamic numbers and will normally fluctuate during the day and from day-to-day.
2) There is some built-in error to our testing. A 464 CD4 count is really not exactly 464. The true number can vary significantly (50 points or more) just based on laboratory conditions. Same for the viral load which can vary up to 3 fold on the test but really be no different. If you run the same blood sample twice you will not get the exact same number. So the trends and basic range is more important than the specific number.
3) When you get to very low viral loads (below 200), the test assay may not be very accurate. In the research clinical trials you need a viral load above 200 to be considered significant. So these viral loads may indeed be "blips".
4) The CD4 counts would be expected to increase as the viral loads are lower. That is what you are seeing. The viral load may be detectable but it is still very low and (presumably) much lower than your pre-treatment levels. So the CD4 should continue to go up.
5) Since you have had this pattern for 2 years it appears to be stable and the values are below 200, so it may be prudent to just continue and observe. Some combinations (especially those containing a protease inhibitor) are better at blocking resistance mutations from developing than others (non-nucleoside reverse transcriptase inhibitors and integrase inhibitors). Some docs may consider "intensifying" the treatment by adding additional drugs or changing to a protease inhibitor (if not already on one) to see if the viral load can be fully suppressed. The downside is that there would be additional pills to take, more chances for side effects and drug interactions. The "intensified" treatment could always be stopped if the viral load pattern was not changed. That is a decision that you would need to make with your medical provider.

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